Pharmacist-led medication reconciliation televisit (MRT) for phase 1 oncology clinical trials: A telemedicine model.

Abstract

1500 Background: Accurate medication reconciliation is critical in oncology trials to mitigate drug-drug interactions (DDIs), address eligibility and enhance patient safety. Cancer patients often experience polypharmacy (≥5 medications), increasing the risk of additive toxicities when investigational agents are introduced. Medication lists in Electronic Medical Records (EMRs) are often incomplete or outdated, complicating eligibility evaluations. To streamline screening for Phase 1 trials, a pharmacist-led medication reconciliation televisit (MRT) model was implemented to improve baseline medication list accuracy and reduce in-clinic time. Methods: From December 2022 to January 2025, one MRT was scheduled for each patient screening for Phase 1 trials (≥18 years, English-speaking or with interpreter support), after trial consent but before registration. Pharmacists reviewed EMRs and dispense histories, then conducted structured phone interviews with patients to review prescription (RX), over-the-counter (OTC), herbal and cannabis product usage, including name, strength, dose, frequency, start dates, indications and ingredients. Inactive medications were discontinued, allergies were updated, patient concerns and medication details were documented in the EMR. Results: A total of 525 MRTs across 82 trials had a median turnaround time of 2 days. Patients (median age 61 years) reported a median of 12 medications (range 2–41) and a median total time spent of 45 minutes (range 5–330) including documentation. 4.8% of patients required interpreter support. Primary cancer types (12 total) included gastrointestinal (32%), breast (20%) and head and neck (11%). Table 1 summarizes MRTs April 2024 and later which captured additional data: 64% required an EMR-prompted outside source reconciliation, 32% modified allergies, a median of 3 medications were added (range 0–37), 2 were changed (range 0-13), 3 were discontinued (range 0-18) and the median call time was 18 minutes. Conclusions: Pharmacist-led MRTs provided substantial value for investigators and research nurses, enabling them to focus on patient care. Flexible scheduling of remote MRTs supported presence of caregivers and medications, reducing list omissions and hospital chair time for patients. Sponsors and study teams gained more accurate baseline records, lowering the risk of unknown prohibited medications. This scalable telemedicine model offers potential for broader use in oncology trials, improving efficiency and patient safety. MRT identification of previously undocumented medications with DDI potential (n=235). > 1 medication on EMR categorized as: Before MRTn (%) After MRTn (%) Absolute Change % Increase RX 208 (98%) 232 (99%) +24 +12% OTC Non-herbal 179 (84%) 224 (95%) +45 +25% OTC Herbal 26 (12%) 46 (20%) +20 +77% Antacid/H2 Blocker/PPI 81 (38%) 107 (46%) +26 +32% Cannabis 11 (5%) 66 (28%) +55 +500%